<!DOCTYPE html>
<html lang="en">

<head>
  <meta charset="utf-8">
  <meta http-equiv="X-UA-Compatible" content="IE=edge">
  <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
  <meta name="description" content="">
  <meta name="author" content="">
  <title>移动医生站 - 入院登记</title>


  <link href="vendor/fontawesome-free/css/all.min.css" rel="stylesheet" type="text/css">
  <link href="bower_components/metisMenu/dist/metisMenu.min.css" rel="stylesheet">
  <link href="bower_components/font-awesome/css/font-awesome.min.css" rel="stylesheet" type="text/css">
  <link href="css/sb-admin-2.min.css" rel="stylesheet">
  <link href="css/my-form-style.css" rel="stylesheet" />
  <!--表单css-->
  <link href="vendor/toast/toast.css" rel="stylesheet" type="text/css">
  <!--toast css-->
  <link href="https://cdn.bootcss.com/bootstrap-datetimepicker/4.17.47/css/bootstrap-datetimepicker.min.css"
    rel="stylesheet">

  <style>
    .a {
      display: flex;
    }

    .copyrights {
      text-indent: -9999px;
      height: 0;
      line-height: 0;
      font-size: 0;
      overflow: hidden;
    }

    label {
      font-weight: 500;
      text-align: right;
    }

    .juzhong {
      text-align: center;
    }

    .touming {
      background-color: rgba(0, 0, 0, 0);
    }

    .blacktext {
      color: black;
    }
  </style>
</head>

<body id="page-top">
  <div id="wrapper">
    <!-- 左侧菜单栏 -->
    <ul class="navbar-nav bg-gradient-primary sidebar sidebar-dark accordion" id="accordionSidebar">
      <!-- Sidebar - Brand -->
      <a class="sidebar-brand d-flex align-items-center justify-content-center" href="#">
        <div class="sidebar-brand-icon rotate-n-15">
          <i class="fas fa-cross"></i>
        </div>
        <div class="sidebar-brand-text mx-3">住院医生站<sup>1.0</sup></div>
      </a>
      <!-- 分割线 -->
      <hr class="sidebar-divider my-0">
      <li class="nav-item active">
        <a class="nav-link " href="p_ruyuandengji.html">
          <i class="fas fa-fw  fa-clinic-medical"></i>
          <span>入院登記</span></a>
      </li>
      <li class="nav-item">
        <a class="nav-link" href="p_bingrenliebiao.html">
          <i class="fas fa-fw fa-address-book"></i>
          <span>病人列表</span>
        </a>
      </li>
      <!-- 分割线 -->
      <hr class="sidebar-divider">
      <li class="nav-item">
        <a class="nav-link " href="p_zhenduanchuli.html">
          <i class="fas fa-fw fa-file-medical "></i>
          <span>诊断处理</span>
        </a>
      </li>
      <li class="nav-item">
        <a class="nav-link " href="p_luruyizhu.html">
          <i class="fas fa-fw fa-file-medical"></i>
          <span>处方处置</span>
        </a>
      </li>
      <li class="nav-item">
        <a class="nav-link" href="p_emr.html">
          <i class="fas fa-fw fa-bible"></i>
          <span>病历书写</span></a>
      </li>
      <li class="nav-item">
        <a class="nav-link" href="p_yijibaogao.html">
          <i class="fas fa-fw fa-bible"></i>
          <span>医技报告</span></a>
      </li>
      <hr class="sidebar-divider">
      <li class="nav-item">
        <a class="nav-link" href="p_emrtemplate.html">
          <i class="fas fa-fw fa-file-image"></i>
          <span>病历模板</span></a>
      </li>
      <li class="nav-item">
        <a class="nav-link" href="p_quanxianguanli.html">
          <i class="fas fa-fw fa-file-image"></i>
          <span>权限管理</span></a>
      </li>
      <hr class="sidebar-divider">
      <!-- Sidebar Toggler (Sidebar) -->
      <div class="text-center d-none d-md-inline">
        <button class="rounded-circle border-0" id="sidebarToggle"></button>
      </div>
    </ul>
    <!-- 左侧菜单栏  -->

    <!-- 右侧内容 -->
    <div id="content-wrapper" class="d-flex flex-column">
      <!---  上中部分 -->
      <div id="content" class="gradient-scooter">
        <!-- 顶端栏 -->
        <nav class="navbar navbar-expand navbar-light bg-white topbar mb-4 static-top shadow"
          style="background-image: linear-gradient(180deg, #ffffff 80%, #e0e0e0 100%);">

          <!-- 隐藏左侧导航栏按钮 -->
          <button id="sidebarToggleTop" class="btn btn-link d-md-none rounded-circle mr-3">
            <i class="fa fa-bars"></i>
          </button>
          <!-- 隐藏左侧导航栏按钮 -->

          <!-- 搜索框模板 -->
          <!-- <form class="d-none d-sm-inline-block form-inline mr-auto ml-md-3 my-2 my-md-0 mw-100 navbar-search">
            <div class="input-group">
              <input type="text" class="form-control bg-light border-0 small" placeholder="Search for..." aria-label="Search" aria-describedby="basic-addon2">
              <div class="input-group-append">
                <button class="btn btn-primary" type="button">
                  <i class="fas fa-search fa-sm"></i>
                </button>
              </div>
            </div>
          </form> -->

          <!-- 右上角个人信息 -->
          <ul class="navbar-nav ml-auto">

            <!-- Nav Item - Alerts -->
            <li class="nav-item dropdown no-arrow mx-1">
              <a class="nav-link dropdown-toggle" href="#" id="alertsDropdown" role="button" data-toggle="dropdown"
                aria-haspopup="true" aria-expanded="false">
                <i class="fas fa-bell fa-fw"></i>
                <!-- Counter - Alerts -->
                <span class="badge badge-danger badge-counter">3+</span>
              </a>
              <!-- Dropdown - Alerts -->
              <div class="dropdown-list dropdown-menu dropdown-menu-right shadow animated--grow-in"
                aria-labelledby="alertsDropdown">
                <h6 class="dropdown-header">
                  医疗消息
                </h6>
                <a class="dropdown-item d-flex align-items-center" href="#">
                  <div class="mr-3">
                    <div class="icon-circle bg-primary">
                      <i class="fas fa-file-alt text-white"></i>
                    </div>
                  </div>
                  <div>
                    <div class="small text-gray-500">2019-12月-12号</div>
                    <span class="font-weight-bold">患者id20011已上传病历</span>
                  </div>
                </a>
                <a class="dropdown-item d-flex align-items-center" href="#">
                  <div class="mr-3">
                    <div class="icon-circle bg-success">
                      <i class="fas fa-donate text-white"></i>
                    </div>
                  </div>
                  <div>
                    <div class="small text-gray-500">2019-12月-12号</div>
                    <span class="font-weight-bold">患者id20014已上传病历</span>
                  </div>
                </a>
                <a class="dropdown-item d-flex align-items-center" href="#">
                  <div class="mr-3">
                    <div class="icon-circle bg-warning">
                      <i class="fas fa-exclamation-triangle text-white"></i>
                    </div>
                  </div>
                  <div>
                    <div class="small text-gray-500">2019-12月-12号</div>
                    <span class="font-weight-bold">患者id20014已上传病历</span>
                  </div>
                </a>
                <a class="dropdown-item text-center small text-gray-500" href="#">显示所有消息</a>
              </div>
            </li>

            <!-- Nav Item - Messages -->
            <li class="nav-item dropdown no-arrow mx-1">
              <a class="nav-link dropdown-toggle" href="#" id="messagesDropdown" role="button" data-toggle="dropdown"
                aria-haspopup="true" aria-expanded="false">
                <i class="fas fa-envelope fa-fw"></i>
                <!-- Counter - Messages -->
                <span class="badge badge-danger badge-counter">7</span>
              </a>
              <!-- Dropdown - Messages -->
              <div class="dropdown-list dropdown-menu dropdown-menu-right shadow animated--grow-in"
                aria-labelledby="messagesDropdown">
                <h6 class="dropdown-header">
                  聊天面板
                </h6>
                <a class="dropdown-item d-flex align-items-center" href="#">
                  <div class="dropdown-list-image mr-3">
                    <img class="rounded-circle" src="https://source.unsplash.com/AU4VPcFN4LE/60x60" alt="">
                    <div class="status-indicator"></div>
                  </div>
                  <div>
                    <div class="text-truncate">喂喂喂</div>
                    <div class="small text-gray-500">梁主任</div>
                  </div>
                </a>
                <a class="dropdown-item d-flex align-items-center" href="#">
                  <div class="dropdown-list-image mr-3">
                    <img class="rounded-circle" src="https://source.unsplash.com/CS2uCrpNzJY/60x60" alt="">
                    <div class="status-indicator bg-warning"></div>
                  </div>
                  <div>
                    <div class="text-truncate">？？？？？？</div>
                    <div class="small text-gray-500">梁护士</div>
                  </div>
                </a>
                <a class="dropdown-item d-flex align-items-center" href="#">
                  <div class="dropdown-list-image mr-3">
                    <img class="rounded-circle" src="https://source.unsplash.com/Mv9hjnEUHR4/60x60" alt="">
                    <div class="status-indicator bg-success"></div>
                  </div>
                  <div>
                    <div class="text-truncate">收到请回复，不然扣工资</div>
                    <div class="small text-gray-500">梁庸医</div>
                  </div>
                </a>
                <a class="dropdown-item text-center small text-gray-500" href="#">获取更多信息</a>
              </div>
            </li>

            <div class="topbar-divider d-none d-sm-block"></div>

            <!-- Nav Item - User Information -->
            <li class="nav-item dropdown no-arrow">
              <a class="nav-link dropdown-toggle" href="#" id="userDropdown" role="button" data-toggle="dropdown"
                aria-haspopup="true" aria-expanded="false">
                <span class="mr-2 d-none d-lg-inline text-gray-600 small">ZERO</span>
                <img class="img-profile rounded-circle" src="https://source.unsplash.com/QAB-WJcbgJk/60x60">
              </a>
              <!-- Dropdown - User Information -->
              <div class="dropdown-menu dropdown-menu-right shadow animated--grow-in" aria-labelledby="userDropdown">
                <a class="dropdown-item" href="#">
                  <i class="fas fa-user fa-sm fa-fw mr-2 text-gray-400"></i>
                  简介
                </a>
                <a class="dropdown-item" href="#">
                  <i class="fas fa-cogs fa-sm fa-fw mr-2 text-gray-400"></i>
                  设置
                </a>
                <a class="dropdown-item" href="#">
                  <i class="fas fa-list fa-sm fa-fw mr-2 text-gray-400"></i>
                  活动日志
                </a>
                <div class="dropdown-divider"></div>
                <a class="dropdown-item" href="#" data-toggle="modal" data-target="#logoutModal">
                  <i class="fas fa-sign-out-alt fa-sm fa-fw mr-2 text-gray-400"></i>
                  登出
                </a>
              </div>
            </li>

          </ul>
          <!-- 右上角个人信息 -->
        </nav>
        <!-- 顶端栏 -->

        <!-- 页面内容 -->
        <div class="container-fluid row">
          <div class="col-md-12">
            <div class="card touming" style="border: 0px;box-shadow: 0px 0px 0px 0px;color: black;">
              <div class="card-body">
                <!-- <div class="card-title text-uppercase text-white"><i class="fa fa-address-book-o"></i> User Registration</div> -->
                <form id="dataform" class="color-form">

                  <div class="form-group row">
                    <label for="name" class="col-sm-1 col-form-label">名字：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="name" placeholder="梁添蜀黍">
                    </div>
                    <label for="patientid" class="col-sm-1 col-form-label">病号：</label>
                    <div class="col-sm-2">
                      <input readonly type="text" class="form-control blacktext" name="patientid"
                        placeholder="0123456789">
                    </div>
                    <label for="pidcard" class="col-sm-1 offset-2 col-form-label">身份证：</label>
                    <div class="col-sm-3 ">
                      <input type="text" class="form-control blacktext" name="pidcard" placeholder="441581199010010000">
                    </div>
                  </div>
                  <hr>
                  <div class="form-group row">
                    <label for="sex" class="col-sm-1 col-form-label">性别：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="sex" placeholder="男">
                    </div>
                    <label for="birthday" class="col-sm-1 col-form-label">出生日期：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="birthday" placeholder="">
                    </div>
                    <label for="phone" class="col-sm-1 col-form-label">电话：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="phone" placeholder="17817832148">
                    </div>
                    <label for="ismarried" class="col-sm-1 col-form-label">婚否：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="ismarried" placeholder="未婚">
                    </div>
                  </div>
                  <div class="form-group row">
                    <label for="company" class="col-sm-1 col-form-label">工作单位：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="company" placeholder="工作单位">
                    </div>
                    <label for="profession" class="col-sm-1 col-form-label">职业：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="profession" placeholder="职业">
                    </div>
                    <label for="linkman" class="col-sm-1 col-form-label">联系人：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="linkman" placeholder="联系人">
                    </div>
                    <label for="linkmantel" class="col-sm-1 col-form-label">联系电话：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="linkmantel" placeholder="联系电话">
                    </div>
                  </div>
                  <hr>
                  <div class="form-group row">
                    <label for="birthprovince" class="col-sm-1 col-form-label">出生地省：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="birthprovince" placeholder="广东省">
                    </div>
                    <label for="birthcity" class="col-sm-1 col-form-label">市：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="birthcity" placeholder="广州市">
                    </div>
                    <label for="birthcounty" class="col-sm-1 col-form-label">区县：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="birthcounty" placeholder="海珠区">
                    </div>
                    <label for="birthaddress" class="col-sm-1 col-form-label">详细地址：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="birthaddress" placeholder="XX区XX街道">
                    </div>
                  </div>
                  <div class="form-group row">
                    <label for="registerprovince" class="col-sm-1 col-form-label">户口地省：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="registerprovince" placeholder="广东省">
                    </div>
                    <label for="registercity" class="col-sm-1 col-form-label">市：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="registercity" placeholder="广州市">
                    </div>
                    <label for="registercounty" class="col-sm-1 col-form-label">区县：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="registercounty" placeholder="海珠区">
                    </div>
                    <label for="registeraddress" class="col-sm-1 col-form-label">详细地址：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="registeraddress" placeholder="XX区XX街道">
                    </div>
                  </div>
                  <div class="form-group row">
                    <label for="hostprovince" class="col-sm-1 col-form-label">居住地省：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="hostprovince" placeholder="广东省">
                    </div>
                    <label for="hostcity" class="col-sm-1 col-form-label">市：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="hostcity" placeholder="广州市">
                    </div>
                    <label for="hostcounty" class="col-sm-1 col-form-label">区县：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="hostcounty" placeholder="海珠区">
                    </div>
                    <label for="hostaddress" class="col-sm-1 col-form-label">详细地址：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="hostaddress" placeholder="XX区XX街道">
                    </div>
                  </div>
                  <hr>
                  <div class="form-group row">
                    <label for="indate" class="col-sm-1 col-form-label">住院日期：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="indate" placeholder="住院日期">
                    </div>
                    <label for="inid" class="col-sm-1 col-form-label">住院号：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="inid" placeholder="住院号" readonly>
                    </div>
                    <label for="inhosopitalnameE" class="col-sm-1 col-form-label">病区：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="inhosopitalnameE" placeholder="病区">
                    </div>
                    <label for="indeptname" class="col-sm-1 col-form-label">科室：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="indeptname" placeholder="科室">
                    </div>
                  </div>
                  <div class="form-group row">
                    <label for="hospitalcardid" class="col-sm-1 col-form-label">医疗卡号：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="hospitalcardid" placeholder="医疗卡号">
                    </div>
                    <label for="premoney" class="col-sm-1 col-form-label">预交金额：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="premoney" placeholder="预交金额">
                    </div>
                    <label for="opdoctorname" class="col-sm-1 col-form-label">门诊医生：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="opdoctorname" placeholder="门诊医生">
                    </div>
                    <label for="opdiagnosename" class="col-sm-1 col-form-label">门诊诊断：</label>
                    <div class="col-sm-2">
                      <input type="text" class="form-control blacktext" name="opdiagnosename" placeholder="门诊诊断">
                    </div>
                  </div>
                  <hr>
                  <div class="form-group row">
                    <label class="col-sm-1 col-form-label"></label>
                    <div class="col-sm-10 ">
                      <button id="submit" type="submit" class="btn btn-link bg-white text-info shadow px-5"><i
                          class="icon-lock"></i> 登记 </button>
                    </div>
                  </div>
                </form>
              </div>
            </div>
          </div>
        </div>
        <!-- 页面内容 -->
      </div>
      <!---  上中部分 -->
      <!-- 底端栏 -->
      <footer class="sticky-footer bg-white">
        <div class="container my-auto">
          <div class="copyright text-center my-auto">
            <span>Copyright &copy; 热爱生活的梁添蜀黍</span>
          </div>
        </div>
      </footer>
      <!-- 底端栏 -->
    </div>
    <!-- 右侧内容 -->

  </div>
  <!--浮空元素 拉到顶端按钮-->
  <a class="scroll-to-top rounded" href="#page-top">
    <i class="fas fa-angle-up"></i>
  </a>

  <!--浮空元素-->
  <div class="modal fade" id="logoutModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel"
    aria-hidden="true">
    <div class="modal-dialog" role="document">
      <div class="modal-content">
        <div class="modal-header">
          <h5 class="modal-title" id="exampleModalLabel">确定退出登录?</h5>
          <button class="close" type="button" data-dismiss="modal" aria-label="Close">
            <span aria-hidden="true">×</span>
          </button>
        </div>
        <div class="modal-body">点击“登出”结束您的会话</div>
        <div class="modal-footer">
          <button class="btn btn-secondary" type="button" data-dismiss="modal">取消</button>
          <a class="btn btn-primary" href="login.html">登出</a>
        </div>
      </div>
    </div>
  </div>


  <!-- 引入JS-->
  <script src="vendor/jquery/jquery.min.js"></script>
  <script src="vendor/jquery-easing/jquery.easing.min.js"></script>
  <script src="vendor/bootstrap/js/bootstrap.bundle.min.js"></script>
  <script src="https://cdn.staticfile.org/axios/0.18.0/axios.min.js"></script>
  <script src="js/sb-admin-2.min.js"></script>
  <script src="vendor/toast/toast.js"></script>
  <script src="js/p_common.js"></script>
  <script src="https://cdn.bootcss.com/moment.js/2.22.0/moment-with-locales.js"></script>>
  <script src="https://cdn.bootcss.com/bootstrap-datetimepicker/4.17.47/js/bootstrap-datetimepicker.min.js"></script>
  <script>
    let url = '/p_patient_inhospital_info';
    $("#submit").click(
      function () {
        var data = $("#dataform").serializeJson();
        console.log(data);
        mypost('/inhospitalinfo',data,function(response){
            mytoast('info',response['msg']);
        });



        //阻止submit的自动刷新
        return false;
      }
    );
    $(function () {
      $('#birthday').datetimepicker({
        format: 'YYYY-MM-DD',//'YYYY-MM-DD HH:mm',
        locale: moment.locale('zh-cn'),
        defaultDate: new Date()
      });
      $('#indate').datetimepicker({
        format: 'YYYY-MM-DD',
        locale: moment.locale('zh-cn'),
        defaultDate: new Date()
      });
    });
  </script>
</body>

</html>
<!--  身份证按钮回车后自动select-->